1 Min In Clinical
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Record learning outcomes
Since September pharmacy owners in England have been required to use an approved clinical IT system for recording clinical records and payment claims for the NHS Blood Pressure Check Service.
These assured systems will enable pharmacy teams to record blood pressure checks in real time and simplify the monthly claims process. Meanwhile, last month, the Summary Care Record application portal started to be replaced by the National Care Records Service.
Development of digital solutions for pharmacy services should enable a seamless flow of clinical communication in and out of community pharmacy systems. Solutions that are interoperable with the NHS allow pharmacy teams to spend more time providing care to patients instead of on administrative tasks.
The sector has started to see these integrations take place in the IT that supports schemes such as NHS flu vaccinations and the Community Pharmacist Consultation Service, where outcomes from the service are updated into the patient’s record held by their GP.
These are obvious signs that IT is becoming a more integral part of the design and delivery of pharmacy services. Such developments couldn’t have happened without considerable behind-the-scenes activity to draw up service specifications for software developers, and to set standards for interoperability and security.
Representing the sector
The Community Pharmacy IT Group (CP ITG) has taken on the mantle of representing the sector’s interests in IT policy development. It evolved from the Pharmacy Voice IT group, which had been in place since the early 2010s.
“The group has a core membership and, since the inception of CP ITG in 2017, we have worked to open the group to a wider range of stakeholders including system suppliers, LPCs and others,” says chairman, Matt Armstrong. “Our aim has been to become more collaborative and gain insights from a wider proportion of the sector.”
The key to success for the implementation of pharmacy IT services in England is, he says, agreement and collaboration on timescales between NHSE, CPE and system suppliers to allow appropriate time to plan in their roadmaps for development. The group provides a forum to allow NHSE to present plans to CP ITG members, to share proposals and get feedback on proposed timelines.
“A key aim for CP ITG is to lead the thinking on how community pharmacy systems can fully integrate into NHS systems,” says Armstrong. “There is still more work to do to enable standardised access to all shared care records and, in future, managing NHS appointments from the National Booking System with existing appointment diaries used in pharmacies.”
He believes pharmacy system suppliers now have a clear roadmap for development for the coming 12 months. Meanwhile, CP ITG is working with the NHSE Transformation Directorate to shape what comes next to further integrate community pharmacy with NHS systems and align it with the future Community Pharmacy Contractual Framework.
“A few of the items that CP ITG will be working on in the coming 12 months are the NHS App, the digital development required for independent prescribing in community pharmacy and future requirements for the next generation EPS,” he says.
Pharmacy tech priority areas
Ensuring information about people’s health and care can be safely and securely accessed, wherever it is needed.
Use of digital to reduce the burden on pharmacy teams, so they can focus on patients, and appropriate infrastructure for the task.
Support the use of digital within pharmacy to improve health and care productivity, patient safety outcomes, and co-operation between pharmacy teams and the health and care system.
Support enabling patients to be able to choose digital tools to access medicines information and pharmacy services directly, so they can receive the best outcomes, recognising the need to also remain inclusive for all patients.
Development and promotion of a wider community pharmacy digital roadmap/vision.
IT priorities
NHS England, DHSC and CP ITG have previously flagged pharmacy IT priorities for contractors in England. These include:
- The Professional Record Standards Body (PRSB) Community Pharmacy Data Standard and associated IT to support the pharmacy contractual framework
- Records access
- Payment and data APIs
- Booking and Referral Standards (BaRS)
- EPS next generation.
The CP ITG is supporting projects in all these areas. Community Pharmacy England is also working with the NHS on next steps to progress the contractual elements. For example, the PRSB, which develops information records standards, has ‘uplifted’ the Community Pharmacy Data Standard to support services within the current contractual framework in England.
This will enable the introduction of possible new services such as menopause (still in the design phase), cancer referral and weight management. Among other things, the uplift enables pharmacy IT systems to capture data on:
- Admission details: a service specification requirement for the smoking cessation service
- Future appointments: a service specification requirement for the smoking cessation service, new medicine service and contraception service
- Problem list: added to ensure inbound data from 111 referrals can be sufficiently captured
- Procedures and therapy: to future-proof the contraception service.
Reducing double data entry for the discharge medicines and new medicine services during the claiming process is something pharmacy has been asking for and should be delivered soon. The estimated date for the API go-live for NMS is December, while DMS will be in the first quarter of next year. An API to support the smoking cessation service is expected in March 2024.
Patient apps are becoming ever more useful. The Department of Health has a roadmap for the NHS App, which includes giving access to NHS 111, using the app for video consultations, and for patient notifications of health checks and screening appointments.
The CP ITG has requested other improvements in the app, such as greater visibility of what has been ordered via the App, common standards and support for other pharmacy apps.
Perhaps the biggest question mark on the horizon – for system suppliers at least – is the next generation of the Electronic Prescription Service. The underlying structure of the current system is based on concepts more than 20 years old and cannot easily be adapted to enable iterative enhancements.
On the radar
Further indications that pharmacy IT is on the NHS radar came in the Government’s delivery plan for recovering access to primary care. Not only did it promise a £645m investment in pharmacy services over the next two years, but it also referenced digital development saying:
“As part of the new funding we will invest to significantly improve the digital infrastructure between general practice and community pharmacy. NHS England will work with community pharmacy and general practice IT suppliers to develop and deliver interoperable digital solutions. These will streamline referrals, provide additional access to relevant clinical information from the GP record, and share structured updates quickly and efficiently following a pharmacy consultation back into the GP patient record.”
The NHS has also confirmed that the GP IT Futures programme is being incorporated into a new framework – Digital Services for Integrated Care – which is expanding to cover other sectors. This could include pharmacy. The framework will publish standards to help suppliers meet technical and clinical requirements, define assurance processes and standardise integration to make it easier for products and services to work seamlessly across healthcare settings.
New provider coming soon
Apotec is a new pharmacy software provider that will be ready for business by the end of the year.
For a new pharmacy system to gain EPS accreditation is a rare event, but Apotec is also the first primary care dispensing system to be accredited for the NHS’s new EPS FHIR standard.
In 2021 NHS England made the decision to move any future accreditation for the EPS in a dispensing environment to a Fast Healthcare Interoperability Resource (FHIR)-based platform, moving away from the existing HL7 architecture. FHIR is a global industry standard for passing healthcare data between systems.
Apotec is led by managing director Ian Taylor, who has considerable experience in pharmacy, co-founding Rx Systems in 2004. Rx was acquired by EMIS in 2010, where he remained in various roles until 2019, when he left to set up Apotec in 2020.
Apotec is an independent company with an independent pharmacy shareholder structure – it is around 70 per cent community pharmacy funded, with supporters including groups like Day Lewis, Cohens and Paydens.
“If we can meet their requirements then we hope to roll out Apotec to their estates. It is a big assumption, but that is the expectation if we meet their requirements,” says Taylor. “That would give us about 70 per cent of the numbers that are needed to make us viable as a provider – you need 1,700-1,800 pharmacies to make things work.”
Apotec will be launching its cloud-based clinical and commercial customer relationship management software (Apotec CRM) later this year. With an open API ethos, the services it supports will be focused on an organisational level patient record, accessible by authorised personnel, free of the restrictions of geographical location.
Key differentiator
This is a key differentiator from PMR systems that focus on local operational prescription fulfilment, says Taylor. “The Apotec model means patients belong to the organisation, not just a pharmacy. It means you can access a customer from anywhere within the company, which allows much greater flexibility to deliver services.”
Being accredited under the NHS FHIR standard also puts Apotec in a good position, he says. “The inevitable change from HL7 to FHIR in community pharmacy will be a significant challenge for the majority of incumbent systems as they have lacked investment in modern technology and continue to operate legacy software.”
Apotec will have all the components of traditional PMRs but is looking to partner in some areas, such as electronic CD register management, and for some NHS services where an accredited IT provider is required.
“We operate an open API ethos and there are a number of suppliers who align with that approach, like Sonar and Pharmsmart. We are happy to work with apps such as Charac and BeWell – that is up to our pharmacy customers and for us to play our part in providing an open API,” says Taylor.
Although the platform will not be ready until the year end, Apotec is happy to talk to interested parties now. “Part of the challenge of switching provider is that you need to think six months in advance,” he says, and urges pharmacies not to sign multi-year contracts without knowing where their provider is going.
Apotec will be offering rolling six-month contracts, leaving pharmacies to provide their own broadband and computer equipment. “We do not mandate hardware or network connectivity but we do provide a secure router to allow role-based access to a pharmacy organisation’s data,” says Taylor.
Clinical
In Clinical
Let’s get clinical. Follow the links below to find out more about the latest clinical insight in community pharmacy.